Socioeconomic position and risk of unplanned hospitalization among nursing home residents: a nationwide cohort study

Background: Socioeconomic inequalities in health and healthcare use in old age have been on the rise during the past two decades. So far, it is unknown whether these inequalities have permeated the nursing home setting. This study aimed to assess whether the socioeconomic position of newly admitted nursing home residents had an influence on their risk of unplanned hospitalization. Methods: We identified older persons (similar to 75 years) who were newly admitted to a nursing home between March 2013 and December 2014 using a set of linked routinely collected administrative and healthcare data in Sweden. The number of unplanned hospitalizations for any cause and the cumulative length of stay were defined as primary outcomes. Unplanned hospitalizations for potentially avoidable causes (i.e. fall-related injuries, urinary tract infections, pneumonia and decubitus ulcers) were considered as our secondary outcome. Results: Among 40 545 newly admitted nursing home residents (mean age 86.8 years), the incidence rate of unplanned hospitalization ranged from 53.9 per 100 person-years among residents with tertiary education up to 55.1 among those with primary education. After adjusting for relevant confounders, we observed no meaningful difference in the risk of unplanned hospitalization according to the education level of nursing home residents (IRR for tertiary vs. primary education: 0.96, 95% CI 0.92-1.00) or to their level of income (IRR for highest vs. lowest quartile of income: 0.98, 0.95-1.02). There were also no differences in the cumulative length of hospital stays or in the risk of experiencing unplanned hospitalizations for potentially avoidable causes. Conclusions: In sum, in this large cohort of newly admitted nursing home residents, we found no evidence of socioeconomic inequalities in the risk of unplanned hospitalization.